Derivation and validation of a multivariate model to predict mortality from pulmonary embolism with cancer: The POMPE-C tool |
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Authors: | Kline Jeffrey A Roy Pierre-Marie Than Martin P Hernandez Jackeline Courtney D Mark Jones Alan E Penaloza Andrea Pollack Charles V |
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Affiliation: | a Department of Emergency Medicine, 1000 Blythe Boulevard, MEB 3rd floor, Room 306, Charlotte, NC 28203b Emergency Department, CHU Angers, Université d'Angers, Francec LUNAM Université, Angers, Franced Christchurch Hospital, Christchurch, New Zealande Department of Emergency Medicine, Feinberg School of Medicine, Northwestern University, Chicago, ILf Department of Emergency Medicine, University of Mississippi Medical Center, Jackson, MSg Emergency Department, Cliniques Universitaires St-Luc, 10 Av. Hippocrate, 1200 Brussels, Belgiumh Department of Emergency Medicine, Pennsylvania Hospital, University of Pennsylvania Health System, 800 Spruce St, Philadelphia, PA 19107 |
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Abstract: | BackgroundClinical guidelines recommend risk stratification of patients with acute pulmonary embolism (PE). Active cancer increases risk of PE and worsens prognosis, but also causes incidental PE that may be discovered during cancer staging. No quantitative decision instrument has been derived specifically for patients with active cancer and PE.MethodsClassification and regression technique was used to reduce 25 variables prospectively collected from 408 patients with AC and PE. Selected variables were transformed into a logistic regression model, termed POMPE-C, and compared with the pulmonary embolism severity index (PESI) score to predict the outcome variable of death within 30 days. Validation was performed in an independent sample of 182 patients with active cancer and PE.ResultsPOMPE-C included eight predictors: body mass, heart rate > 100, respiratory rate, SaO2%, respiratory distress, altered mental status, do not resuscitate status, and unilateral limb swelling. In the derivation set, the area under the ROC curve for POMPE-C was 0.84 (95% CI: 0.82-0.87), significantly greater than PESI (0.68, 0.60-0.76). In the validation sample, POMPE-C had an AUC of 0.86 (0.78-0.93). No patient with POMPE-C estimate ≤ 5% died within 30 days (0/50, 0-7%), whereas 10/13 (77%, 46-95%) with POMPE-C estimate > 50% died within 30 days.ConclusionIn patients with active cancer and PE, POMPE-C demonstrated good prognostic accuracy for 30 day mortality and better performance than PESI. If validated in a large sample, POMPE-C may provide a quantitative basis to decide treatment options for PE discovered during cancer staging and with advanced cancer. |
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Keywords: | Pulmonary embolism Outpatient Risk stratification Malignancy Prognosis Decision rule Treatment |
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